An Online Mindfulness-based Intervention for Certified Nursing Assistants in Long-term Care.

Purpose: Certified nursing assistants (CNAs) make up the largest segment of the long-term care (LTC) setting workforce, however, they are at high risk of job dissatisfaction and burnout. Evidence suggests that mindfulness-based interventions (MBIs) might be particularly relevant and useful for CNAs in reducing psychological distress, improving job satisfaction, and reducing burnout, but little research has investigated this possibility. A feasibility study of an online MBI for CNAs in LTC settings was therefore conducted. Methods: CNAs completed assessments at baseline and posttest. Paired t-tests assessed changes in mindfulness, psychological distress (i.e., depressive and anxiety symptoms, and stress), and professional quality of life. Results: Of the 19 CNAs who started the intervention, N = 13 (68%) completed it and provided postintervention data. Depressive symptoms were significantly decreased postintervention (F = 6.26, p = .036, d = .47). Conclusions: MBIs may have beneficial effects for CNAs in LTC settings. Further research with a larger CNA population will increase the power and relevance of these findings, ultimately contributing to the improvement of patient outcomes in LTC.

A Policy Analysis of State Plans for Independent Living in the U.S.

People aging with disability and people of retirement age depend upon their respective states to follow the philosophical tenets of independent living (IL) to remain self-sufficient in their communities with a high quality of life. Independent living services are specified, programmatic sets of services funded by the Administration for Community Living (ACL) in line with expressly stated goals for implementation by state agencies for their state indepdent living centers (SILCSs) to implement through a State Plan for Independent Living (SPIL). Designated state agencies are required to submit their SPIL every three years to maintain funding through the ACL. This policy analysis of funded state plans for inclusion of people with disability aimed to determine which SPILs promote the IL philosophies of consumer choice and control. To this end, qualitative and quantitative content analyses were done to evaluate SPIL's inclusion of IL philosophies. Specifically, the consumer choice and control philosophy, involvement of people with disability, as well as the coherency of IL services from state to state were reviewed. The results of this paper indicate disparities in consumer choice and control initiatives across states, with approximately half of all states clearly promoting consumer control initiatives in their plans. Only three states made it clear that people with disability were involved in the SPIL development. The results give direction for nursing organizations who wish to work with and support SILCs as they advocate for person-centered approaches for people with disability.

Advanced Practice Registered Nurse Transition to Practice in the Long-Term Care Setting: An Ethnography.

Advanced practice registered nurses are successful in improving quality outcomes and filling provider care gaps in long-term care. However, little is known about the nurse's transition to practice in this setting. A 12-month ethnography was conducted via participant-observation with nine advanced practice registered nurses in five long-term care facilities to understand practice environment influence on the nurses' transition and on the reciprocal influence of the nurse on the practice environment. Transition was fraught with uncertainty as documented by five themes: where's my authority, institutional acceptance, personal role fulfillment, provider relationships, and individual versus organizational care. These findings suggest that transition in this setting is complex, characterized by insecurity whether the individual is new to advanced practice or experienced. Transition in long-term care could be strengthened by formal programs that include clinical practice, reconceived mentorship for advanced practice registered nurses, and education designed to improve comfort and expertise with indirect care.

A qualitative analysis of the meaning of aging for women with disabilities with policy implications.

This is a report of a hermeneutic phenomenological study of the meaning of aging for women with childhood-onset disabilities due to the effects of paralytic polio. Twenty-five women aged 55-65 years were interviewed 2 to 4 times regarding their life course experiences and the meaning they assigned to aging. Field notes, audiotaped interviews, life course charts, and demographics were used in thethematic analysis that produced 5 themes: Bodies Change, Disrupted Meaning, The Unpredictibility of Aging, Slowing Down, and Changing Perspective. Overall, the findings indicate that the experiences of disability due to the result of paralytic polio could not be separated from the experiences of aging, which ultimately led the author to question policies that distribute and fund benefits based on age and disability status without an understanding of the varied experiences of women with disabilities.

Complementary and alternative therapy use in persons with multiple sclerosis.

Use of complementary and alternative therapies (CATs) is common with both the general population and with people who have multiple sclerosis (MS). The purpose of this study was to describe the reported use and perceived effectiveness of different CATs in a large sample (N = 621) of people with MS. One-third of the participants reported that they were presently using one or more CATs, and 50% had tried one or more CATs in the past. Most CATs were perceived as being helpful. People who were presently using CATs differed little from those who were not with regard to demographic- and illness-related variables. Use of CATs was positively associated with the practice of other health-promoting behaviors. The frequent use of different CATs suggests that clinicians should systematically and nonjudgmentally inquire about CAT use among their patients.